INSTRUCTIONS FOR RENEWAL OF REGISTRATION OF A TRADEMARK OR SERVICE MARK (See Form TM2) Item 1 Applicant (owner name and address): The applicant is the individual or entity that owns the mark. The name of the applicant (owner) is listed on the current certificate of registration. If the applicant is a partnership, each individual must sign the application before a notary public. If the name of the owner of the mark has changed from that as listed on the current certificate of registration, it is necessary that the following be filed in addition to the renewal application: Certificate of Name Change Form TM3 (filed when the name of the owner of the mark has changed and there is no change in the entity type); or Application for Assignment (filed when the owner of record has relinquished ownership of the mark). An assignment is always required when the entity type has changed. A non-refundable fee of $30.00 made payable to the Treasurer of Virginia must be submitted along with a Certificate of Name Change and/or an Application for Assignment in addition to the renewal registration fee. Contact person name and address: Name and address of person we may contact with any questions we may have. Please furnish an email address, if available. Applicant is a: Indicate the entity type (i.e. corporation, limited liability company, etc.) and the applicant's state or jurisdiction of formation. If the entity type has changed from that as listed on the current certificate of registration, an Application for Assignment must be submitted to this division. On the_ day of __: Indicate the date the mark was first registered. The date is listed on the renewal notification letter. In the name of: Indicate the owner of the mark as listed on the current certificate of registration. Identify the trademark or service mark (or attach an exhibit): Indicate the mark, which is shown on the current certificate of registration. Type or write the words if the mark is comprised of words only. If the mark also includes a design, symbol or image, attach a blank piece of paper with an appearance of the mark only without extraneous markings. The registration cannot be renewed if the registered mark has changed. Class number(s) of goods or services: Identify the class number(s) of goods or services. A non-refundable registration fee of $30.00 made payable to the Treasurer of Virginia must be submitted for each classification number listed on the current certificate of registration. If the class number(s) has changed from that shown on the current certificate of registration, the registration cannot be renewed. Describe the product or service(s) the mark represents (identifies): Describe the product(s) or service(s) provided which the mark(s) identifies as shown on the current certificate of registration. If the description of the mark has changed from that as shown on the current certificate of registration, the registration cannot be renewed. Specimen: Demonstrate use of the mark, on a specimen, as used in commerce in the State of Virginia. A trademark specimen may be an original label, photograph or packaging of the product to which a label is clearly affixed, brochure, etc. A service mark specimen may be an original business card, letterhead, brochure, advertisement dated within the past year along with the name and date of the publication, etc. Signature of applicant & notary public ­ The application must be signed before a notary public. Additional assistance can be obtained by calling (804) 371-9051 or at www.scc.virginia.gov/srf. Mailing address: Division of Securities & Retail Franchising, PO Box 1197, Richmond, VA 23218 Item 2 Item 3 Item 4 Item 5 Item 6 Item 7 Item 8 Item 9 Item 10 American LegalNet, Inc. www.FormsWorkFlow.com TM 2 (11/09) COMMONWEALTH OF VIRGINIA STATE CORPORATION COMMISSION DIVISION OF SECURITIES AND RETAIL FRANCHISING APPLICATION FOR RENEWAL OF REGISTRATION OF A TRADEMARK OR SERVICE MARK (Please type or print) Applicant (owner) name and address:____________________________________________________________________ __________________________________________________________________________________________________ Contact person name and address:_______________________________________________________________________ ___________________________________Daytime phone:__________________Fax number:______________________ Applicant is a:_______________________________Applicant's state or jurisdiction of formation: ___________________ (entity type i.e. corporation, partnership, etc) On the ___________ day of _________________________, ______, the mark identified below was registered in the name of:___________________________________________________________________________________________ Identify the trademark or service mark (or attach an exhibit of the exact mark): __________________________________________________________________________________________________ Class number(s) of goods or services:____________________________________________________________________ Describe the product(s) or service(s) the mark represents (identifies):___________________________________________ __________________________________________________________________________________________________ PLEASE NOTE: A specimen of the mark must accompany this application. If the applicant is not the registrant named above, the applicant is the assignee to whom a new certificate was issued on the _____________ day of ________________________________, _____. The applicant asserts that it is the owner of this mark and that the mark has been and is still in use in the Commonwealth of Virginia. No other person has the right to use this mark in Virginia, either in the identical form thereof or in such near resemblance thereto as to be likely, when applied to the goods or services of such person, to cause confusion or mistake, or to deceive. (NOTE: The application must be signed in the name of the applicant, either by the applicant or by a person authorized by the applicant. The application must be sworn to by the person who signed the name of the applicant.) Signature:________________________________________________________Date:_____________________________ Signer's Name:____________________________________________________Title:_____________________________ (print or type) State of:__________________________________, County/City of:______________________________________, to-wit: The foregoing application was subscribed and sworn to